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Maternal complications and cesarean section without indication: systematic review and meta-analysis

OBJECTIVE: The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS: A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stage...

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Autores principales: Mascarello, Keila Cristina, Horta, Bernardo Lessa, Silveira, Mariângela Freitas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Faculdade de Saúde Pública da Universidade de São Paulo 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697917/
https://www.ncbi.nlm.nih.gov/pubmed/29166440
http://dx.doi.org/10.11606/S1518-8787.2017051000389
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author Mascarello, Keila Cristina
Horta, Bernardo Lessa
Silveira, Mariângela Freitas
author_facet Mascarello, Keila Cristina
Horta, Bernardo Lessa
Silveira, Mariângela Freitas
author_sort Mascarello, Keila Cristina
collection PubMed
description OBJECTIVE: The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS: A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals. RESULTS: The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92–5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48–0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88–2.81). CONCLUSIONS: The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure.
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spelling pubmed-56979172017-11-30 Maternal complications and cesarean section without indication: systematic review and meta-analysis Mascarello, Keila Cristina Horta, Bernardo Lessa Silveira, Mariângela Freitas Rev Saude Publica Review OBJECTIVE: The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. METHODS: A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals. RESULTS: The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92–5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48–0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88–2.81). CONCLUSIONS: The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure. Faculdade de Saúde Pública da Universidade de São Paulo 2017-11-13 /pmc/articles/PMC5697917/ /pubmed/29166440 http://dx.doi.org/10.11606/S1518-8787.2017051000389 Text en https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Mascarello, Keila Cristina
Horta, Bernardo Lessa
Silveira, Mariângela Freitas
Maternal complications and cesarean section without indication: systematic review and meta-analysis
title Maternal complications and cesarean section without indication: systematic review and meta-analysis
title_full Maternal complications and cesarean section without indication: systematic review and meta-analysis
title_fullStr Maternal complications and cesarean section without indication: systematic review and meta-analysis
title_full_unstemmed Maternal complications and cesarean section without indication: systematic review and meta-analysis
title_short Maternal complications and cesarean section without indication: systematic review and meta-analysis
title_sort maternal complications and cesarean section without indication: systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697917/
https://www.ncbi.nlm.nih.gov/pubmed/29166440
http://dx.doi.org/10.11606/S1518-8787.2017051000389
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